Why we don't have a quick fix for ebola

Ebola is a truly frightening disease, with a fatality rate as
high as 95 percent (although the death rate in the current outbreak in
West Africa is only 55 to 60 percent).

At the moment, it is
largely confined to a heavily forested inland area where the borders
of Liberia, Sierra Leone, and Guinea meet, although cases have already
appeared in the capital cities of all three countries.

It
could get much worse. If Ebola successfully made the jump to a more
prosperous, densely populated country like Nigeria, whose citizens
travel all over the world, the current 800 recorded deaths could become
8,000, or 80,000, or even more. And the worst of it is that there is
no effective vaccine or treatment for Ebola.

Let me rephrase that. There is no approved
vaccine or treatment for Ebola. There are candidates, some of which
have shown promising results when tested on non-human primates. But
they haven’t gone through the full testing process that is necessary
before they are approved for human use, because nobody was willing to
pay for it.

The normal procedure in the United States, home to
more than half of the world’s major drug companies (“Big Pharma”), is
that basic research for new drugs may be paid for by government grants
or even by private philanthropy (like Bill Gates’s $200 million
donation for research on a malaria vaccine), but the work of bringing
the drugs to market is left to the commercial companies. All too
often, they simply can’t be bothered.

It costs hundreds of
millions of dollars to take a drug through the whole approval process
and put it on the market. That’s worthwhile if the drug will then sell
at a high cost and be used regularly over long periods of time: a
drug that fights “rich people’s diseases” like cancer or heart
disease, say, or even something like Viagra.

But a one-shot vaccine that would mainly be used by poor Africans will never make a profit, so it is ignored.

Galvanized
by the panic over Ebola, the National Institutes of Health in the
United States has now scheduled phase one trials of an Ebola vaccine
on human subjects for next month. But there are two more phases after
that, and the earliest a vaccine could be approved for general use is
next July. And even in this emergency, it’s public money, not Big
Pharma, that is funding the research.

The problem goes much
wider than Ebola and other tropical diseases. It extends,
unfortunately, to the antibiotics that vanquished the bacterial
infections that were once responsible for about 25 percent of adult
deaths.

The last new class of antibiotics, carbapenems, was
approved in 1980. Since then, nothing—even though the usefulness of
existing antibiotics is rapidly eroding as resistant strains of
bacteria emerge.

That’s a big threat, but antibiotics are still
not big money-makers, as they are used for relatively short periods of
time to fight some specific infection. So no new type of antibiotic
has been developed by Big Pharma for more than three decades.

A
minimum of 23,000 people in the United States died last year of
infections that would once have been easily ended by antibiotics; in the
European Union the total was 25,000.

There are some measures
that would dramatically slow the spread of antibiotic-resistant
bacteria. Far fewer prescriptions should be written for antibiotics,
and doctors should be monitored to ensure that they are not
over-prescribing. Patients must complete any course of antibiotics
that they begin, and report that they have done so. Over-the-counter
sales of antibiotics in countries like China and Russia must cease.

Above
all, it should be a criminal offence to feed antibiotics to animals
just to make them grow faster and bigger. (That is where 80 percent of
the antibiotics consumed in the United States go at the moment.) And
even when all that has been done, the rise of antibiotic-resistant
bacteria will continue, though at a much slower pace. Bacterial
resistance is an evolutionary process that can only be slowed, not
stopped.

So we desperately need new antibiotics, and there are
none forthcoming. Without them, warned Dame Sally Davies, chief
medical officer for England, “Modern medicine would quickly go out of
the window.”

Almost all surgery, including things as
commonplace as caesarian sections and hip replacements, and most
cancer treatments as well, involve a significant risk of infection
that must be controlled by antibiotics. As Prime Minister Davd Cameron
told The Time”: “If we fail to act...we are cast back into the
dark ages of medicine, where treatable infections and injuries will
kill once again.”

Yet Big Pharma will not fill the gap, for
those companies are answerable to their shareholders, not to the
public. The case for direct state intervention to finance the
development of the vaccines and antibiotics that the commercial sector
neglects is overwhelming. And very urgent.

Gwynne Dyer is an independent journalist whose articles on world affairs are published in 45 countries.